Liver transplantation choice of donor
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Liver transplantation choice of donorLiver transplantation choice of donor includes laboratory testing for donors includes ABO blood type, Complete blood count, Prothrombin time, Activated partial thromboplastin time, Hepatitis B surface antigen, anti-hepatitis B core antigen, anti-hepatitis C virus, anti-HIV antibody, venereal disease research laboratory, rapid plasma reagin, anti-cytomegalovirus antibody, and nucleic acid testing for HIV and HCV. Donor risk index is a predictive model comprised of donor factors known at the time an organ is offered to quantify the risk of graft failure.
Liver transplantation choice of donor
Laboratory testing for donors includes:[1]
- ABO blood type[2]
- Complete blood count
- Prothrombin time
- Activated partial thromboplastin time
- Hepatitis B surface antigen (HBsAg)
- Anti-hepatitis B core antigen (HBc)
- Anti-hepatitis C virus (HCV)
- Anti-HIV antibody
- Venereal disease research laboratory
- Rapid plasma reagin
- Anti-cytomegalovirus antibody
- Nucleic acid testing for HIV and HCV
Donor risk index
- A predictive model comprised of donor factors known at the time an organ is offered to quantify the risk of graft failure, and this model is known as the donor risk index.[3]
- The parameters most strongly associated with graft loss include increasing donor age, donation after cardiac death, and use of split grafts.
- The index includes:
| Age |
| <40 |
| 40-49 |
| 50-59 |
| 60-69 |
| >69 |
| Cause of Death |
| Trauma |
| Anoxia |
| Cerebrovascular Accident |
| Other |
| Race |
| African American |
| White |
| Other |
| Donation after Cardiac Death |
| Partial/Split Liver Graft |
| Height |
| Organ Location |
| Cold time |
1.00
40-49 1.17
50-59 1.32
60-69 1.53
>70 1.65
1.19
1.07
1.16
1.20
1.51
1.52
Hepatitis C-positive donors
- Transplantation of livers from hepatitis C virus-positive donors into HCV+ recipients initially may cause recurrent liver disease due to introduction of new viral strains into the recipient.[4]
Hepatitis B-positive donors
- Liver transplantation from donors with serologic markers for HBV infection has the potential to increase the donor pool.[5]
- It is generally recommended that grafts from hepatitis B core antibody positive donors should be offered to hepatitis B surface antigen positive recipients.
- Recipients who lack HBV markers may also be eligible provided that they receive effective HBV prophylaxis post-transplantation.
- The use of hepatitis B immunoglobulin or an oral antiviral agent reduces the risk of HBV infection in HBsAg-negative patients who receive an HBcAb-positive liver.
References
- ↑ Kucirka LM, Alexander C, Namuyinga R, Hanrahan C, Montgomery RA, Segev DL (2009). "Viral nucleic acid testing (NAT) and OPO-level disposition of high-risk donor organs". Am J Transplant. 9 (3): 620–8. doi:10.1111/j.1600-6143.2008.02522.x. PMID 19191766.
- ↑ Kluger MD, Guarrera JV, Olsen SK, Brown RS, Emond JC, Cherqui D (2012). "Safety of blood group A2-to-O liver transplantation: an analysis of the United Network of Organ Sharing database". Transplantation. 94 (5): 526–31. doi:10.1097/TP.0b013e31825c591e. PMID 22874840.
- ↑ Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA; et al. (2006). "Characteristics associated with liver graft failure: the concept of a donor risk index". Am J Transplant. 6 (4): 783–90. doi:10.1111/j.1600-6143.2006.01242.x. PMID 16539636.
- ↑ Bowring MG, Kucirka LM, Massie AB, Luo X, Cameron A, Sulkowski M; et al. (2017). "Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era". Am J Transplant. 17 (2): 519–527. doi:10.1111/ajt.13976. PMC 5266634. PMID 27456927.
- ↑ Marroquin CE, Marino G, Kuo PC, Plotkin JS, Rustgi VK, Lu AD; et al. (2001). "Transplantation of hepatitis C-positive livers in hepatitis C-positive patients is equivalent to transplanting hepatitis C-negative livers". Liver Transpl. 7 (9): 762–8. doi:10.1053/jlts.2001.27088. PMID 11552208.